MEDICARE: KIPP MIAMI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1790543098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIPP MIAMI INC

Provider Business Mailing Address
First Line	:	60 PARK PL STE 802
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07102-5508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NW 110TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33167-3707
Country	:	US
Telephone Number	:	786-822-7702
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF ESE
Name	:	JACLYN VALDES
Credential	:
Telephone Number	:	305-989-4454

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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